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Power Of Attorney Address Change

IN THE UNITED STATES PATENT AND TRADEMARK OFFICE

In Patent of: [Name]

Patent No.:

Issued on: [Date]

For: [Item]

To the Honorable Commissioner of Patents and Trademarks:

Please make the following change to the above patent which was granted to [Name of Inventor] on the date noted above:

[Check the Item Which Applies and Fill in the Appropriate Information].

[ ] Change the address of the attorney(s) of record to:

[ ] Change the correspondence address of the patent owner to:

[ ] Add a power of attorney to, and address any future correspondence to, the following person whom I appoint to handle all business pertaining to the above patent in the Patent and Trademark Office:

[ ] I hereby revoke and remove all previous powers of attorney and enter a power of attorney in favor of the following person whom I hereby appoint to transact all business pertaining to the above patent in the Patent and Trademark Office. All future correspondence should be addressed to this person as well:

The person whose signature appears below is certified to have the authority to make these requested changes in the patent.

Dated:

Signature

Full Name

[Note: Following the Signature, acknowledge as to whether the person who signs this document is the Patent Owner or the owners attorney or approved agent].

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss: [Date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[Signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)